From the Cardiovascular Center, Chiba-Hokusoh Hospital (M.M., T.Y., J.A., Y.S.) and Department of Cardiovascular Medicine (K.Y., W.S.), Nippon Medical School, Tokyo, Japan; and Tama-Nagayama Hospital & Nippon Medical School, Tokyo, Japan (H.A.).
Circ Arrhythm Electrophysiol. 2014 Jun;7(3):490-6. doi: 10.1161/CIRCEP.113.001416. Epub 2014 Apr 24.
Measuring postpacing intervals (PPIs) is the standard maneuver for localizing reentrant tachycardia circuits. However, changes or termination of the tachycardia during entrainment pacing, or difficulties in defining the correct local activity, limit the use of PPIs.
We hypothesized that the number of pacing stimuli needed to entrain (NNE) was useful for mapping intra-atrial reentrant tachycardias. First, 10 patients with typical atrial flutter were studied to characterize the NNE. Next, 317 entrainment attempts in 30 patients with 76 intra-atrial reentrant tachycardias were analyzed to determine the efficacy of the NNE. The NNE was small at sites within the reentrant circuit (median 2) and large at remote sites during typical atrial flutter. The NNE depended on the pacing cycle length and coupling interval of the initial paced beat, where the NNE became smaller at shorter pacing cycle lengths and coupling intervals. The NNE highly correlated with the difference between the PPI and tachycardia cycle length (r = 0.906; P<0.001). When the pacing cycle length and coupling interval were 16 to 30 ms below the tachycardia cycle length, a NNE ≤2 and >3 predicted a PPI-tachycardia cycle length ≤20 and >20 ms, respectively, with 100% accuracy. Thirty-six (11%) entrainment attempts changed or terminated intra-atrial reentrant tachycardia. Importantly, the NNE remained valid in those cases. Furthermore, the NNE provided additional information in cases with some difficulties with PPI measurements.
The NNE is a simple and reliable criterion, which facilitates mapping intra-atrial reentrant tachycardia.
http://www.clinicaltrials.gov. Unique identifier: NCT001747.
测量起搏后间期（PPIs）是定位折返性心动过速环的标准方法。然而，在夺获起搏时心动过速的改变或终止，或难以确定正确的局部活动，限制了 PPIs 的使用。
我们假设夺获所需的起搏刺激次数（NNE）对心房内折返性心动过速的标测有用。首先，研究了 10 例典型的心房扑动患者，以描述 NNE。接下来，分析了 30 例患者 317 次夺获尝试中的 76 次心房内折返性心动过速，以确定 NNE 的效果。在折返环内的部位 NNE 较小（中位数为 2），而在典型心房扑动时的远处部位较大。NNE 取决于初始起搏的起搏周期长度和耦合间隔，其中在较短的起搏周期长度和耦合间隔时 NNE 变小。NNE 与 PPI 和心动过速周期长度之间的差异高度相关（r = 0.906；P<0.001）。当起搏周期长度和耦合间隔比心动过速周期长度短 16 至 30 毫秒时，NNE ≤2 和 >3 分别预测 PPI-心动过速周期长度≤20 和 >20 毫秒，准确率为 100%。36 次（11%）夺获尝试改变或终止了心房内折返性心动过速。重要的是，在这些情况下 NNE 仍然有效。此外，NNE 在某些情况下 PPI 测量存在困难时提供了额外的信息。
NNE 是一种简单可靠的标准，有助于心房内折返性心动过速的标测。
